Longitudinal analysis of sniff nasal inspiratory pressure assessed using occluded and un-occluded measurement techniques in amyotrophic lateral sclerosis and primary lateral sclerosis

IF 2.5 4区 医学 Q2 CLINICAL NEUROLOGY Amyotrophic Lateral Sclerosis and Frontotemporal Degeneration Pub Date : 2019-07-17 DOI:10.1080/21678421.2019.1639194
Deirdre Murray, J. Rooney, Anna Campion, Lauren Fenton, Michaela Hammond, M. Heverin, D. Meldrum, H. Moloney, R. Tattersall, O. Hardiman
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引用次数: 11

Abstract

Abstract Objective: Sniff nasal inspiratory pressure (SNIP) is a commonly used clinical measure of respiratory impairment in amyotrophic lateral sclerosis (ALS), which is used to guide the initiation of noninvasive ventilation (NIV). SNIP can be completed with either an occluded or an un-occluded contralateral nostril. The aim of this study was to compare occluded and un-occluded SNIP measurements and to examine the decline in occluded SNIP over time compared to the ALSFRS-R respiratory subscore. Methods: This was a prospective longitudinal study examining occluded and un-occluded SNIP scores in ALS and PLS patients recorded between 2001 and 2018. Bland and Altman graphs were plotted for occluded vs. un-occluded SNIP measurements taking account of the repeated measures nature of the data. Longitudinal models were constructed as linear mixed effects multi-level models with follow-up in ALS limited to 6 years. Results: SNIP measured with an occluded contralateral nostril was systematically higher than with an un-occluded nostril. SNIP measured using both methods declined non-linearly, particularly after 2–3 years. The best fit model for decline in occluded SNIP included a main effect and interaction between site of onset and time, with age and diagnostic delay as independent variables. This showed a linear decline in spinal onset with a floor effect in bulbar-onset ALS. Conclusion: SNIP measured with an occluded and un-occluded contralateral nostril is not interchangeable, which is relevant in interpreting thresholds for initiation of NIV. SNIP declines non-linearly, which is explained in spinal onset ALS by age and diagnostic delay, but an apparent floor effect remains in bulbar onset.
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在肌萎缩性侧索硬化症和原发性侧索硬化症中,使用闭塞和未闭塞的测量技术评估鼻部吸气压力的纵向分析
摘要目的:嗅鼻吸气压(SNIP)是肌萎缩侧索硬化症(ALS)呼吸障碍的一种常用临床测量方法,用于指导无创通气(NIV)的启动。SNIP可以通过对侧鼻孔闭塞或未闭塞来完成。本研究的目的是比较闭塞和未闭塞SNIP测量值,并检查与ALSFRS-R呼吸分量表相比,闭塞SNIP随时间的下降。方法:这是一项前瞻性纵向研究,检查2001年至2018年间记录的ALS和PLS患者的闭塞和未闭塞SNIP评分。考虑到数据的重复测量性质,绘制了闭塞和未闭塞SNIP测量的Bland和Altman图。纵向模型被构建为线性混合效应多层次模型,ALS的随访时间限制为6年。结果:对侧鼻孔闭塞测得的SNIP系统性高于未闭塞鼻孔。使用这两种方法测量的SNIP呈非线性下降,尤其是在2-3年后。闭塞SNIP下降的最佳拟合模型包括主要影响以及发病部位和时间之间的相互作用,年龄和诊断延迟是自变量。这表明脊髓性肌萎缩侧索硬化症的发病率呈线性下降,并伴有基底效应。结论:用封闭和未封闭的对侧鼻孔测量SNIP是不可互换的,这与解释NIV启动阈值有关。SNIP呈非线性下降,这在脊髓性发作的ALS中可以通过年龄和诊断延迟来解释,但在延髓性发作中仍然存在明显的基底效应。
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来源期刊
CiteScore
5.40
自引率
10.70%
发文量
64
期刊介绍: Amyotrophic Lateral Sclerosis and Frontotemporal Degeneration is an exciting new initiative. It represents a timely expansion of the journal Amyotrophic Lateral Sclerosis in response to the clinical, imaging pathological and genetic overlap between ALS and frontotemporal dementia. The expanded journal provides outstanding coverage of research in a wide range of issues related to motor neuron diseases, especially ALS (Lou Gehrig’s disease) and cognitive decline associated with frontotemporal degeneration. The journal also covers related disorders of the neuroaxis when relevant to these core conditions.
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